Sign up to be a Lipoedema UK Ambassador

Lipoedema UK Ambassador

PLEASE COMPLETE DETAILS:

First Name *

Last Name *

EMAIL ADDRESS TO RECEIVE UPDATES FROM LIPOEDEMA UK REGARDING AMBASSADOR TRAINING PROGRAMMES & INFORMATION

Email *

Phone *

Location/Post Code *

Are you a driver and do you have your own transport?

Current Age

Do you have any special circumstances /needs that we should be aware of to ensure your safety whilst volunteering with us?

Employment Status

How many days (roughly) per month/year are you able to allocate to Lipoedema UK?

I am a Healthcare Practitioner

Yes No

I am a Lipoedema Patient

Yes No

Please outline any relevant experience , previous professional/personal skills, expertise and or special interests that would be beneficial for your volunteer role with Lipoedema UK?

Tell us about why you want to volunteer for Lipoedema UK

What Geographical Regions are you able to cover?

Are you wiling to stay overnight if required? *